Benefits Glossary & Definitions

B

Beneficiary

A person who will receive benefits (ie insurance settlement or pension funds) should the insured person die.

C

Child

A child is a natural, legally adopted, step or foster child of the Employee or Spouse, who is unmarried, not engaged in full-time employment, and is dependent on the Employee or Spouse and under age 21. Those older than 21, but younger than 25 are eligible if they are enrolled in full-time attendance at an accredited educational institution. When your child turns 21 you will be sent a form to complete to determine eligibility for continued coverage.

Claim

A request for payment under your benefit plan.

Co-insurance Arrangement

For some benefits you and Western share the cost of the expense. For example, most common dental expenses and prescription costs are shared with Western paying 85% of the cost and you paying 15% of the cost. The maximum you would pay in any calendar year would be $450 for singles and $900 for those with family coverage. You may use your Health Care Spending Account to seek reimbursement for the portion of expenses not covered by Western.

Conversion

Upon leaving or retiring from Western, some employees are able to convert their life insurance or other benefits at Western to a plan where the employee pays the full cost of the premium for those benefits. Please contact Human Resources for more details.

Coordination of Benefits

If you or your dependent(s) are covered under Western’s benefit plan, and are also covered under another plan (your spouse’s) for the same expenses, you may, in many cases coordinate the payments of claims in such a way to cover the total cost of the claim. You may not, in any case, receive reimbursement for any amount beyond the actual cost incurred.

D

Death Benefit

The amount of money paid to a beneficiary when a person insured under a life insurance policy dies.

Dependents

Eligible dependents include your spouse and your children. See definitions of spouse and child for more details.

Dependent Tuition Scholarship Plan

A benefit available to those with full time employment at Western that pays an annual scholarship for higher education provided the student achieves a specified academic level. This is available to certain qualifying children and, in the case of faculty, also applies to the spouse of the employee.

Disability Insurance

A program which provides, in exchange for premiums, a stream of monthly benefit payments to an employee of the university who is injured or who has an illness which lasts longer than 15 calendar weeks.

Dispensing Fee

The amount charged by a pharmacist to dispense a prescription drug.

E

Eligible Expenses

These are expenses that are covered under your contract with Western, and under Western’s contract with our benefit provider. The eligibility of some expenses is also prescribed by the Tax Act of Canada – for example, only items or services considered as a medical expense under the Tax Act, may be claimed under your Health Care Spending Account.

Evidence of Good Health

Statements of medical evidence of a person’s health affecting eligibility for coverage.

Extended Health Plan

A benefit that provides reimbursements for a number of health care costs not covered by the Ontario Health Insurance Plan or other provincial health plan.

F

Flex Credits

A benefit available to some employees that allows them, each Nov/Dec to assign specified dollar credits toward either their Health Care Spending Account or their Professional Expense Reimbursement Account (PER).

H

Health Care Spending Account (HCSA)

Your Health Care Spending Account provides reimbursement for a broad range of health-related expenses over and above your Extended Health and Dental Plan. You can use your HCSA to seek reimbursement for the amount of an eligible expense not covered by your plan. Be aware that only items or services considered as a medical expense under the Tax Act, may be claimed under your Health Care Spending Account.

O

Out of Pocket Maximum

The portion of eligible expenses subject to the 85/15 coinsurance which an Employee must pay before the plan pays eligible expenses at 100%. The maximum amount you would pay in copayments for claims under the Extended Health and Dental plans would be $450 per calendar year for employees with Single coverage and $900 per calendar year for employees with Family coverage.

P

Premium

The cost of insurance coverage. Some premiums are paid by Western, some by the employee and some premium costs are shared.

Predetermination

If your dentist has recommended dental treatment that is expected to cost more than $500, you should have your dentist prepare a pre-treatment plan. This will allow you to determine your own financial obligation prior to the commencement of treatment.

Professional Expense Reimbursement Allowance (PER)

An annual benefit available to some employees to allow them to purchase work-related computer software, professional membership, to attend conferences, etc.

R

Resident

A person who is a resident of Canada, as defined in the Income Tax Act.

S

Spouse

A spouse is legally married to the Employee or is a person of the opposite or same sex who has continuously lived with the Employee for at least one year.